370806125-12-4-2019-20-CC-YBAZ-BJK4D8-20191204180020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370806125
Report Date: 12/04/2019
Date Signed: 12/04/2019 06:00:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	SO. BAY FAM. YMCA - EASTLAKE ELEM.		FACILITY NUMBER:	370806125
ADMINISTRATOR:	CAT NOBLEJAS		FACILITY TYPE:	840
ADDRESS:	1955 HILLSIDE DRIVE		TELEPHONE:	(619) 421-4798
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	60	CENSUS: 20	DATE:	12/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Ashley Ruby		TIME COMPLETED:	06:05 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct an annual random inspection. Upon arrival LPA Baez met with lead teacher in charge, Ashley Ruby. The following ratios were observed:

Room 705 (Serves 4.9 years through 12 years of age):

There were 20 children present with 3 staff members

Multi- purpose Room (Serves 4.9 years through 12 years of age):

This room was not inspected because staff did not have access to the room. Ms. Ruby stated that the MPR is rarely ever used and would only be used to serve snacks to the children on rainy days when they are not able to use the outside covered porch area (located on black top).

Appropriate ratios and capacity were observed.

Furniture and age appropriate equipment is in good condition indoors and outdoors. Children have access to gender specific restrooms labeled "Boys" and "Girls" and is located on the elementary school campus near Room 202. The toilets and hand washing facilities are sanitary. Room 705 is safe and clean. The center is responsible for providing snacks and the snack menu is posted. Drinking water is readily accessible inside of the classroom through the use of water fountain. Children have access to water outside of the classroom through a water fountain. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, and are in good repair. The outdoor play area is fenced, children have access to the black top area which includes the following: covered porch area, tether ball courts, wall ball area, and basketball courts. The play area has covered porch area used for shade. There are no bodies of water or weapons at this facility. Emergency drills are being conducted every month, last emergency drill was conducted on 11/2019. There is an operational smoke detector and carbon monoxide detector at the facility. ...CONTINUED ON 809C...

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SO. BAY FAM. YMCA - EASTLAKE ELEM.	FACILITY NUMBER: 370806125
	VISIT DATE: 12/04/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

First Aid/CPR was reviewed and is in compliance. Staff records of education, training, and/or experience were reviewed and are in compliance.

LPA reviewed the following with Ashley Ruby: IMS, SIDS, Car seat Law, and Shaken Baby Syndrome. This facility does provide Incidental Medical Services- IMS. A written plan of operation has already been submitted to CCL and is on file. The following information regarding ADA was provided, US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Ms. Ruby and she understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Facility is compliant with SB792.

LPA Baez discussed the new Mandated Reporter training, AB1207. LPA Baez reminded Ms. Ruby that all staff members are to take the training and have the printed certificates present at the facility and available for review. Facility is compliant with AB1207.

There were not any deficiencies issued throughout today's annual inspection. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed the posting the Notice of Site Visit.

Duty Line: (619) 767-2248, Monday through Friday from 8am to 5pm. To access our Regulation and Forms please use our WEBSITE: http://ccld.ca.gov

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2